Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

What The Patient Does

There are a number of injured workers who will (for reasons outlined below) cling to a belief even in the absence of findings to support that belief. The concept of the hypochondriac is quite real.

They may not have the pain complaints to support the diagnosis to which they cling. Nonetheless, they tell family, friends and each new doctor, that this is their diagnosis. They may also offer that they have been encouraged to have a procedure (EG. spinal fusion) and have not as yet acted upon that recommendation.

In these cases, the patient is not deliberately trying to lead mislead you. They are dealing with their own morbid fears of their future, their financial insecurity, the growing unwillingness of the family to be supportive and their perception of a future without options.

You will find that merely providing them with more and more data that counters their belief has no positive effect. They have begun a lifestyle that they believe is warranted by the _diagnosis_ to which they cling.

They may be successful in finding a surgeon to perform a procedure (or procedures) based upon their continued subjective complaints. It is this latter possibility that is truly alarming, and this is where they run their greatest risk.

There are three things that can be done for them:

a. Once the objective findings are established, be certain that treatment is tied to those findings, not to the patient_s disortions

b. Be certain that the patient has been evaluated and hypochondriasis, not depression, is the true source of these unsubstantiated complaints

c. Have the patient consistently engage in productive activities within their functional capacity, rather than allow daily activities to be determined by distorted beliefs. These may include: